Design

Setting

Participants

110 women between 20 and 60 years. All women were from low income households and most were married, had children, had had
a Papanicolaou (Pap) test within the previous few years, and had a family doctor. Women were recruited by a coalition of community
agencies using poster announcements placed in community centres and distributed in the neighbourhood.

Methods

Skilled women facilitators conducted 11 focus group sessions using open ended questions about women's experiences of accessing
health care, concerns about cervical screening, and suggestions for cervical screening recruitment strategies. Sessions were
audiotaped and data were transcribed and analysed by individuals and the coalition to identify salient phrases or sentences,
categories, and themes.

Main findings

4 themes were identified. The first theme, being able to talk with doctors is important, described women's need to have access to the doctor without barriers (eg, limited office hours, difficulties in getting child
care or transportation, and long waiting times); conversations with the doctor that were unhurried, provided easy to understand
information, and did not make the woman feel “stupid”; and a sense of comfort and trust with the doctor.

The second theme, being treated as a person is important, focused on women's interactions with the healthcare system. Women wanted to be cared for holistically rather than just for
their physical health, to be sensitively listened to, and to have privacy during a Pap test.

The third theme, finding answers to many questions about cancer is important, emphasised that women had many questions about cancer treatment options, outcomes, and side effects; cancer prevention; and
where to find good information sources.

The fourth theme, having a Pap test is uncomfortable, related to women's uncertainties about the purpose of the Pap test and the actual procedure. Many women needed to mentally
prepare for the Pap test and felt it was an embarrassing, humiliating, and unpleasant experience.

Conclusion

When accessing health care for cervical screening, women placed importance on having good communication with the doctor even
with limited time, being respected as a person with emotions, having their many questions answered, and having their Pap test
done with sensitivity and a caring attitude.

Cervical cancer is an ideal target for screening. More than 90% of cervical cancer can be detected by the Pap test.1 This test detects cellular changes in premalignant stages before symptoms of advanced cervical cancer arise. With appropriate
use of this simple screening procedure, nearly all cervical cancer deaths are preventable. Yet, this ideal remains unachieved
without widespread patient observance of cervical screening recommendations. Fitch et al examined how cancer screening programmes should be designed to entice more women to adopt established cervical screening
recommendations.

The qualitative design of this study was its main strength. The use of focus groups for data collection permitted group interaction
and captured social and community elements of the patients' perceptions. The findings underscore the value of listening and
seeking feedback from patients to improve services.

It is difficult to get data from non-users of health services, so it is uncertain whether women who do not get Pap tests feel
similarly to those sampled here. Although there may be additional elements that prevent non-users from using services, the
data offer insights into areas that need attention. These findings should be disseminated to a broad audience of healthcare
providers, especially physicians, who do most Pap tests.

This research shows that there is much more to providing health services than medical science and technology; consumers do
not relinquish their human qualities when they enter providers' offices. Nurses can play an active part in patient education
by helping women to identify their information needs and by ensuring that women understand the information they receive. They
can also be patient advocates with the physician by identifying any negative previous experiences the patient has had with
cervical screening.